General Discussions

Newly diagnosed patients with cancer experienced improvements in quality of life and lower levels of distress by participating in a web-based stress management program, according to results of a study presented at the 2017 ASCO Annual Meeting.

The randomized study demonstrated that most of the participants reported feeling distressed at baseline and that a structured online program guided by psychologists was an effective method of offering them assistance, researchers said when discussing the findings during a presscast in advance of the presentation.

“Our online stress management program was feasible with newly diagnosed cancer patients during active treatment,” said lead study author Viviane Hess, MD, a medical oncologist at the University Hospital of Basel in Switzerland. “We were able to reach cancer patients via the Internet. At baseline, 3 of 4 patients were highly distressed, so we reached a target population in need of support.”

Hess said most patients who receive a cancer diagnosis experience a “high level of distress,” but do not have access to psychological support. She said studies in patients without cancer have shown that web-based, therapist-guided interventions can be as effective in helping individuals cope with mental disorders such as anxiety and depression.

In order to meet such needs, oncologists and psychologists designed the STREAM program as an intervention that covers 8 weekly topics such as bodily reaction to stress, cognitive stress reduction, feelings, and social interactions. For each topic, participants receive written and audio information and complete exercises and questionnaires. Psychologists review patients’ feedback on a weekly basis and offer written guidance and support through a secure online portal; patients can then respond in writing.

To test the STREAM program, 129 patients newly diagnosed with cancer were randomized within 12 weeks of starting anticancer treatment to an immediate intervention (n = 64) or to a control group who would have access to the program after a 2-month period (n = 65). The psychologists were based in Basel, but the patients were living in Germany, Switzerland, and Austria.

Overall, the median age of the participants was 52 years (range, 46-58) and 84.5% were female. The cancer diagnoses covered approximately 10 tumor types; more than 70% had breast cancer while 8.5% had lymphoma, 5.4% each had gynecological or gastrointestinal tract cancers, 3.9% had lung cancer, 3.1% had central nervous system or head and neck cancer, 2% had urogenital tract cancer, and 0.8% had skin or soft tissue cancer. Eighty-six percent had localized disease while 14% had metastatic disease.

To evaluate the program, investigators measured quality of life including fatigue using the Functional Assessment in Cancer Therapy-Fatigue (FACIT-F) scale, psychological distress with Psychological distress on the Distress Thermometer (DT), and anxiety and depression with the Hospital Anxiety and Depression Scale (HADS).

Investigators found that patients who participated in the intervention program experienced significantly improved quality of life with FACIT-F scores that were an average of 8.59 points higher (range, 2.45-14.73; P = .007). Similarly, those who received the intervention had a greater improvement in their distress levels, with an average 0.85 decline on the DT scale (range, -1.60 to -0.10; P = .03). Anxiety and depression as measured by the HADS score also declined for the intervention group by 1.28 points (range, -3.02 to 0.45) but this difference was not statistically significant (P = .15).

Hess said the findings support the use of remote technologies. “I think online psychological support will be much more important in the years to come, as the digital generation reaches the age when they are at higher risk of cancer. For them, it will be natural to use such online tools and communicate without face-to-face interaction, and so now is the time to standardize and validate the tools,” Hess said in a press release.

Researchers plan to translate the STREAM program, which is currently available only in German, into other languages.

Commenting on the research, ASCO expert Don S. Dizon, MD, FACP, said the study demonstrated the value of psychological support after therapy starts. He said most oncologists assume patients will experience distress when initially diagnosed but that such feelings would abate as they undergo curative therapy.

“Trying to get these patients support can be an issue because they’re at cancer centers quite frequently for medical therapy,” he said. “Trying to squeeze psychological expertise into their treatment plans can become difficult. Utilizing an online system not only has been shown to be feasible, but the promise of being effective as well is quite grounded now in an evidence-based randomized trial.”
Hess V, Grossert A, Alder J, et al. Web-based stress management for newly diagnosed cancer patients (STREAM): A randomized, wait-list controlled intervention study. J Clin Oncol. 2017;35 (suppl; abstr LBA10002).